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Petersen HIV Clinics | Center for Regenerative & Restorative Medicine

 

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Patient Information & Forms

Required Forms (all patients)

PHC Release of Information (English) / (Spanish)

Communications Preferences (English) / (Spanish)

PHC Notice of Privacy Practices (English) / (Spanish)

Patient Information

Admission for Services/Inclusions and Limitations

Patient Rights and Responsibilities/Facility Rights and Responsibilities

Grievance and Complaint Policy

Cap on Charges/Cap on Specialty Charges

Imposition of Charges 

Emergency Financial Assistance Request

Consent for an Assistor

PATIENT RESOURCES

  • Patient Rights & Responsibilities
  • Patient Forms & Information
  • Paying for Care
  • Education & Resources
  • Consumer Advisory Board
Petersen HIV Clinics | University of Arizona Health Sciences

Mailing Address
655 N. Alvernon Way, Ste. 210
Tucson, AZ  85711
Tel: (520) 626-8598
Fax: (520) 626-6352

Outpatient North
Banner-University Medical Center North
3838 N. Campbell Ave, Bldg 2
Tucson, AZ  85719

Outpatient South
Banner-University Medical Center South
2800 E. Ajo Way
Tucson, AZ  85713


We respectfully acknowledge the University of Arizona is on the land and territories of Indigenous peoples. Today, Arizona is home to 22 federally recognized tribes, with Tucson being home to the O’odham and the Yaqui. The University strives to build sustainable relationships with sovereign Native Nations and Indigenous communities through education offerings, partnerships, and community service.


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